BACKGROUND Monitoring cerebral regional oxygen saturation (rSO2) in low-risk coronary surgery patients avoided cerebral deoxygenation and improved outcome (1). We hypothesized that lower rSO2 values would be associated with higher incidence of neurologic complications and longer intensive care unit (ICU) stay in high-risk cardiac surgical patients. METHODS: Fifty high-risk patients (EuroScore >5) were monitored during cardiac surgery with cerebral near infrared spectroscopy (NIRS) to estimate rSO2. Interventions to improve cerebral deoxygenation (defined as a 20% reduction of rSO2 below baseline) were based on an algorithm for the use of NIRS on optimizing factors that influence cerebral oxygen supply/demand (e.g., perfusion pressure and cardiac output, arterial oxygen content, haemoglobin, and the cerebral metabolic rate of O2). RESULTS: Patients who exhibited major neurologic complications were 28%. They needed longer duration of mechanical ventilation (MV) (58±69 vs 20±52 hours, p = 0.041) and ICU stay (8.3±8.4vs 2.6±2.7 days, p = 0.001) than patients without a neurologic complication. Baseline rSO2 values were significantly lower in patients facing major neurologic complications (Dx 60.1±1.9 vs 64.7±1.2 %, p = 0.04; Sx 61.6±1.6 vs 66.6±1.2 %, p = 0.03) who also exhibited more episodes of cerebral desaturation during surgery (3.0 vs 1.5, p = 0.004). There was a significant inverse correlation between intraoperative rSO2 and duration of MV (r = - 0.68) and length of ICU stay (r = -0.62). CONCLUSION: Preoperative rSO2 values are associated with an increased risk of neurologic dysfunction. Cerebral oxygen desaturation during cardiac surgery is associated with prolonged MV needs and ICU stay. REFERENCES: Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007 Jan;104(1):51-8.
Scolletta, S., Franchi, F., M., S., C., G., V., I., E., M., et al. (2012). Cerebral oxygen desaturation is associated with neurologic complications and longer intensive care unit stay in high-risk cardiac surgery patients. In Suppl Intensive Care Med.
Cerebral oxygen desaturation is associated with neurologic complications and longer intensive care unit stay in high-risk cardiac surgery patients
SCOLLETTA, SABINO;FRANCHI, FEDERICO;
2012-01-01
Abstract
BACKGROUND Monitoring cerebral regional oxygen saturation (rSO2) in low-risk coronary surgery patients avoided cerebral deoxygenation and improved outcome (1). We hypothesized that lower rSO2 values would be associated with higher incidence of neurologic complications and longer intensive care unit (ICU) stay in high-risk cardiac surgical patients. METHODS: Fifty high-risk patients (EuroScore >5) were monitored during cardiac surgery with cerebral near infrared spectroscopy (NIRS) to estimate rSO2. Interventions to improve cerebral deoxygenation (defined as a 20% reduction of rSO2 below baseline) were based on an algorithm for the use of NIRS on optimizing factors that influence cerebral oxygen supply/demand (e.g., perfusion pressure and cardiac output, arterial oxygen content, haemoglobin, and the cerebral metabolic rate of O2). RESULTS: Patients who exhibited major neurologic complications were 28%. They needed longer duration of mechanical ventilation (MV) (58±69 vs 20±52 hours, p = 0.041) and ICU stay (8.3±8.4vs 2.6±2.7 days, p = 0.001) than patients without a neurologic complication. Baseline rSO2 values were significantly lower in patients facing major neurologic complications (Dx 60.1±1.9 vs 64.7±1.2 %, p = 0.04; Sx 61.6±1.6 vs 66.6±1.2 %, p = 0.03) who also exhibited more episodes of cerebral desaturation during surgery (3.0 vs 1.5, p = 0.004). There was a significant inverse correlation between intraoperative rSO2 and duration of MV (r = - 0.68) and length of ICU stay (r = -0.62). CONCLUSION: Preoperative rSO2 values are associated with an increased risk of neurologic dysfunction. Cerebral oxygen desaturation during cardiac surgery is associated with prolonged MV needs and ICU stay. REFERENCES: Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007 Jan;104(1):51-8.
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https://hdl.handle.net/11365/40355
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